Despite the availability of highly effective measures for primary prevention,
dental caries (tooth decay) remains one of the most common childhood chronic diseases
(1). When properly placed, dental sealants are almost 100% effective in preventing
caries on the chewing surfaces of first and second permanent molar teeth
(2). However, sealants remain underused, particularly among children from low-income families
and from racial/ethnic minority groups (3). Schools traditionally have been a setting
for both dental disease prevention programs and for oral health status assessment.
To determine the prevalence of dental sealant use among third grade students
from schools with and without sealant programs, during the 1998--99 school year, the
Ohio Department of Health conducted an oral health survey among schoolchildren.
This report summarizes the results of this survey, which indicate that targeted,
school-based dental sealant programs can substantially increase prevalence of
dental sealants. Providing sealant programs in all eligible, high-risk schools could reduce
or eliminate racial and economic disparities in the prevalence of dental sealants.

The study population was derived from a sample of elementary schools in
Ohio. Eligible schools included those with complete data on enrollment and that
participated in the free or reduced-cost lunch program. Of 1857 public schools with complete
data, 335 (representing 87 of 88 Ohio counties) were selected randomly using
the probability-proportional-to-size approach. The prevalence of dental sealant use
was compared among students attending schools with a program (69 schools) to that
of students attending schools without a program (266 schools). On the basis of a
student census in randomly selected classrooms (grades 1--3), 34,668 students were
eligible for the survey; 19,471 of these were from the third grade. Parental consent
was obtained and oral screenings performed on 11,191 third graders (57.5% of
those eligible). Using mouth mirrors, artificial lighting, and dental explorers, 12
dental professionals completed the clinical screening. Weighted data were analyzed
using Stata software (4). The Design-Based Pearson Statistic was used to test
for association. Weighting was based on the relation between the number of
children screened and the number in the underlying eligible population.

Among third grade students surveyed in Ohio, 34.2% (95% confidence
interval [CI]=32.1%--36.4%) had at least one dental sealant on a permanent molar tooth.
At schools with dental sealant programs, 56.7% of third grade students had a
sealant, compared with 28.2% of students at schools without sealant programs (Table 1).
By race, 61.6% of white third grade students in schools with sealant programs
had sealants, compared with 30.0% of white third grade students in schools
without programs. For black third grade students, 50.8% in schools with sealant programs
had a sealant, compared with 17.7% of black third grade students in schools
without programs.

Using eligibility for free or reduced-cost lunch programs as a proxy for low
income, 54.4% of eligible third grade students in schools with sealant programs had a
sealant, compared with 64.8% of third grade students not eligible for the program in the
same schools; 19.0% of eligible third grade students in schools without programs had
a
sealant. Among third grade students in schools with sealant programs, the
prevalence of sealants was similar for students with and without health insurance.

Among students who attended schools with sealant programs and had sealants
on their teeth, 70.2% (95% CI=62.8--76.7) received them at school. Students who
received sealants at school represented 22.6% of all Ohio students with sealants.

Editorial Note:

The findings in this report indicate that school-based dental
sealant programs in Ohio that are targeted to groups at high risk for dental caries and
least likely to receive regular dental care can substantially increase sealant
prevalence. Third grade students in schools with dental sealants programs have two to
three times greater prevalence of sealants compared with students in schools
without sealant programs. One of the national health objectives for 2010 is to increase to
50% the proportion of children aged 8 years that have received dental sealants on
their first permanent molar teeth (3). Periodic surveys in Ohio have documented
steady increases in the overall prevalence of dental sealants among children aged 8
years, from 11% during 1987--1988 to 26% during 1992--1993 to 30% during 1998--1999
(5). Although the overall prevalence still falls short of the 2010 objective, among
targeted schools, all racial and income groups have achieved or exceeded the
objective. Providing programs in all eligible, high-risk schools would accelerate progress
toward both achieving the 2010 objective and eliminating racial and income disparities.

School-based sealant programs began in Ohio during the mid-1980s,
expanding from a single demonstration program in one city in 1984 to 18 programs in 34 of
88 counties in 2000. During 1997--1998, approximately 12,000 second grade
students received sealants through Ohio school-based programs.

The findings in this report are subject to at least two limitations. First, it is
not known to what extent the 42% of third grade students who did not return
parental consent forms were similar to the students who did. In addition, it is unknown
whether those without consent were equally distributed according to other factors that
could influence the findings (e.g., receipt of regular dental care). Second, parental
recall about whether children received sealants at school was subject to error. As a
result, for this analysis, only children who attended a school with a sealant program, had
a sealant on at least one tooth, and had a consent form indicating that they had
received sealants at school were counted in that category.

The findings of this survey indicate that, among students who participated, the
use of appropriately targeted school-based programs increases the prevalence of
dental sealants among children from low-income families and reduces the racial and
income disparity in sealant prevalence among elementary school students. The extent
to which sealant programs can eliminate the disparity in sealant prevalence in
a population will be influenced by the manner in which the programs are targeted
and by their penetration in the targeted population. Sealant programs provide
additional benefits when they are linked to programs that ensure access to primary dental
care for those in need of restorative services.

References

US Department of Health and Human Services. Oral health in America: a report of
the Surgeon General. Rockville, Maryland: National Institute of Dental and Craniofacial
Re
search, 2000.

American Dental Association, Council on Dental Materials and Devices, and Council
on Dental Therapeutics. Pit and fissure sealants. J Am Dental Assoc 1971;82:1101--3.

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